Acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls

A 73-year-old male with a history of diabetes mellitus was admitted to our hospital for acute renal failure. An ultrasonogram revealed bilateral hydronephrosis, which worsened despite insertion of a bladder catheter. Nephrostomy catheters were positioned bilaterally, and Candida albicans was found in the urine culture. The patient was successfully treated with intermittent direct irrigation and i.v. antifungal agent therapy. Since 1977, approximately 50 cases of fungus balls or fungal bezoars in the urinary tract have been reported, but the majority of these cases have been characterized by unilateral ureteral or bladder involvement. Herein, we report a case of acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls.     

The Role of the Biopsy in Diagnosis of Early Gastric Cancer

In order to determine the reliability of endoscopic biopsy indiagnosis of early gastric cancer, and to clarify the problemswith biopsies, preoperative endoscopic biopsies from 771 earlygastric cancer cases were reviewed and analyzed clinicopathologicallyin comparison with surgically resected specimens. The 771 cancerswere surgically resected at the National Cancer Center Hospitalduring the period from 1972 to 1982. Definite histological diagnosiswas obtained in 87.4% of the carcinomas at the initial biopsies.Repeated biopsy raised the percentage of correct definite diagnosesto 96.1%. False-negative (including suspicion of cancer) diagnosiswas most frequent in the case of depressed lesions (50 lesions).Half of the false negatives were found to be due to samplingerrors by the endoscopists. The other half of these 50 lesionswere diagnosed as "suspicious of malignancy" because of thehistological difficulty in differentiating early gastric cancerfrom regenerative atypia with intestinal metaplasia, or becausethere was not enough information, or for the other reasons.Most of the 31 false-negative diagnoses at the initial biopsyfrom elevated lesions were reported as adenoma (group III) orsuspicious of carcinoma (group IV), indicating that differentialdiagnosis between well-differentiated adenocarcinoma and adenomais very difficult. The result of the present study suggeststhat repeated biopsy from correct sites and discussion of thelesions between clinicians and pathologists are very important. ^**Present affiliation: Toranomon Hospital, Toranomon 2-2-2,Minato-ku, Tokyo 105, Japan.     

Metastatic Tumors of the Stomach Detected by Endoscopy

Thirteen patients with gastric metastasis were examined endoscopicallyand their diseases were diagnosed histologically at the NationalCancer Center Hospital from 1962 to 1980. Their endoscopic findings were analyzed. The metastatic lesionwas solitary in 10 of the 13 cases and multiple (9 lesions)in three. Although 12 of the 13 cases showed elevated lesionsendoscopically, ulcerated hemispherical nodules, which correspondto the "bull's-eye sign" of Pomerantz roentgeno-graphically,were observed in only four cases. In the remaining nine casesthe endoscopic findings were submucosal tumor without centraldepression (2 cases), a cancer-like appearance (6 cases) orextragastric compression (1 case). The majority of these metastatic lesions (9 of the 19; 47.3%)were located along the greater curvature of the stomach. Fromthese results, the elevated lesion of the greater curvaturemight suggest a metastatic tumor regardless of the conventionalcriteria (multiplicity or ulcerated hemispherical nodule) whenthe patient has cancer in other organs.     

Nonulcerative Lesion Detected by Endoscopy as an Early Expression of Gastric Malignancy: --Retrospective Observation of 72 Cases of Gastric Carcinoma--

To evaluate the endoscopic criteria for early malignant findingsof gastric carcinoma more precisely, a retrospective examinationof endoscopic pictures of 72 patients with gastric carcinomawas carried out. The patients had received endoscopic examinationsrepeatedly for years and proceeded finally to surgery on thebasis of a diagnosis of carcinoma by gastric biopsy. The macroscopicas well as microscopic findings of the resected specimens werecompared with the previous endoscopic observations. Ulcerative lesions were predominantly found at the initial endoscopyin patients whose final diagnosis was the lie type of earlygastric cancer or IIc-like advanced cancer. These patients usuallyreceived endoscopic examinations repeatedly and their lesionswere diagnosed as malignant by the adopted criteria of earlygastric cancer 2 to 6 yr after the initial examination. In contrast, nonulcerative lesions were observed more frequentlyat the initial examination in patients with the final diagnosisof the IIa+IIc type of early gastric cancer or Borrmann typeof advanced cancer. In most of those patients endoscopic examinationwas not carried out so frequently, and in some of those whohad been closely followed the malignant findings appeared rathersuddenly with tumorous formation as well as deeper invasionduring less than a few years from the previous examination atwhich the tumor had been considered benign. These data indicate that the nonulcerative lesions which wereconsidered benign could be the early expression of gastric carcinoma.It should be stressed that nonulcerative lesions such as "irregularerythematous change, discoloration, flat granular change" and"simple mucosal depression" observed in some parts of the stomachwould be important site for the detection of early gastric carcinoma,and that these lesions need to be biopsied more frequently.     

Urine Growth Hormone Determinations Compared with Other Methods in the Assessment of Growth Hormone Secretion

Okuno, A., Yano, K., Itoh, Y., Hashida, S., Ishikawa, E., Mohri, Z-I. and Murakami, M. (Department of Paediatrics, Asahikawa Medical College, Hokkaido; Medical College of Miyazaki, Kiyotake, Miyazaki; and Research and Development Division, Sumitomo Pharmaceuticals Co Ltd, Hyogo, Japan). Urine growth hormone determinations compared with other methods in the assessment of growth hormone secretion. Acta Paediatr Scand [Suppl] 337:74, 1987.
Urinary excretion of hGH was studied in children with short stature using a sensitive sandwich enzyme immunoassay technique. Urinary hGH excretion, in terms of hGH: creatinine ratio, showed excellent correlation with the mean and peak hGH values during physiological and pharmacological tests. It seems that the urinary hGH levels reflect serum hGH profiles during the urine collection period. A border zone for the lower limits of normal hGH levels in the urine was 7.5–13.4 ng/g creatinine for the physiological test at night (from 2000 hours to 0600 hours) and 17.4–35.0 ng/g creatinine for the pharmacological tests. Assessment of hGH secretory status by the urinary hGH levels showed good agreement with the serum hGH response. Measurement of urinary hGH could be used as a diagnostic test for impaired hGH secretion, and the multiple blood drawing required in physiological and pharmacological tests might be replaced by urine sampling.     

Inflammatory esophagogastric polyp and fold in an adolescent

The case of a 13 year old boy with an inflammatory esophagogastric polyp and ulcerative colitis is described. Endoscopy revealed a typical polyp and gastric fold complex at the esophagogastric junction and a hiatal hernia. Histology of a biopsy specimen confirmed an inflammatory polyp covered by hyperplastic squamous and gastric foveolar epithelium. Continuous 24 hour esophageal manometry suggested gastroesophageal reflux, which may be related to the pathogenesis of the lesion. Follow-up endoscopy showed marked regression of the polyp with medication for reflux eosphagitis. This clinical entity is rare in childhood and adolescence, and the manifestations may not be readily recognized. Therefore, endoscopic biopsy is important in children with esophageal polyps. However, polypectomy is unnecessary except when malignancy is suspected or when symptoms persist.     

Endoscopic ultrasonography in a child with chronic pancreatitis

In a case with chronic pancreatitis and pseudocysts related to muscular cytochrome—c oxidase deficiency, endoscopic ultrasonography (EUS) was performed to morphologically examine the pancreas for features that may have been missed by abdominal computed tomography and pancreatography. Conventional abdominal sonography had failed to show valuable diagnostic information of chronic pancreatitis in this case. EUS demonstrated several new findings. Parenchymal atrophy was remarkable, especially in the pancreatic tail, and a dilated pancreatic main or branch duct was clearly found in the region. Moreover, pancreatic stones in the main duct were also distinctly proved. EUS may become a useful new diagnostic method in pediatric gastroenterology, especially when sufficient findings are not obtained by conventional imaging techniques. However, an ultrasonographic endoscope with a shorter rigid portion and smaller caliber should be developed for pediatric patients.     

Acute disseminated encephalomyelitis associated with Mycoplasma pneumoniae infection

An 8 year old girl with acute disseminated encephalomyelitis (ADEM) is described. Elevated serum antibody titers suggested recent Mycoplasma pneumoniae infection. T2-weighted image of magnetic resonance imaging (MRI) disclosed multiple lesions of high signal intensity in bilateral basal ganglia and thalami as well as in the white matter. Postcontrast T1-weighted image revealed an enhanced lesion in the deep white matter. She showed rapid clinical improvement in response to corticosteroid therapy. The lesions had disappeared completely on MRI performed 10 weeks after the onset. ADEM is believed to be a demyelinating disorder of probable autoimmune etiology. MRI findings in this case may support the hypothesis that the primary pathological event is vascular injury and demyelination occurs only as a secondary phenomenon.     

A Case of Multiple Ectopic Pheochromocytomas Occurring in the Urinary Bladder and the Para-Aortic Region

A patient with urinary bladder pheochromocytoma and anotherpheo-chromocytoma in the para-aortic region is presented. Also,nine cases which have already been reported in Japan are reviewed. The following conclusions are made: bladder pheochromocytomacan appear at any age in either sex. The clinical triad consistingof hypertension, gross intermittent or transient painless hematuriaand micturitional attacks typical of pheochromocytoma are seenin most cases. Attention is called to such urinary bladder